Citation Nr: 0728597
Decision Date: 09/12/07 Archive Date: 09/25/07
DOCKET NO. 06-11 661 ) DATE
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On appeal from the
Department of Veterans Affairs Regional Office in Des Moines,
Iowa
THE ISSUES
1. Entitlement to an increased evaluation for service-
connected residuals of shell fragment wound of the left
wrist, currently evaluated as 10 percent disabling.
2. Entitlement to an increased evaluation for service-
connected residuals of shell fragment wound of the right
hand, currently evaluated as 30 percent disabling.
3. Entitlement to an increased evaluation for service-
connected status post radiation therapy for prostate cancer
with residual urinary frequency and urgency, currently
evaluated as 40 percent disabling.
4. Entitlement to an increased evaluation for service-
connected frequency of stools with urgency secondary to
radiation as residual of prostate cancer treatment, currently
evaluated as 30 percent disabling.
5. Entitlement to an initial evaluation in excess of 30
percent for post-traumatic stress disorder.
REPRESENTATION
Appellant represented by: Veterans of Foreign Wars of
the United States
WITNESS AT HEARING ON APPEAL
Appellant
ATTORNEY FOR THE BOARD
David S. Ames, Associate Counsel
INTRODUCTION
The veteran served on active duty from June 1967 to April
1970.
This matter comes properly before the Board of Veterans'
Appeals (Board) on appeal from a rating decision by the
Department of Veterans Affairs (VA) Regional Office in Des
Moines, Iowa (RO).
In February 2007, the veteran raised the issue of entitlement
to a total disability rating for compensation purposes based
on individual unemployability. This issue has not been
developed for appellate review and is therefore referred to
the RO for appropriate disposition.
The appeal is remanded to the RO via the Appeals Management
Center, in Washington, DC.
REMAND
The veteran seeks increased ratings for residuals of shell
fragment wound of the left wrist, currently evaluated as 10
percent disabling, residuals of shell fragment wound of the
right hand, currently evaluated as 30 percent disabling,
status post radiation therapy for prostate cancer with
residual urinary frequency and urgency, currently evaluated
as 40 percent disabling, frequency of stools with urgency
secondary to radiation as residual of prostate cancer
treatment, currently evaluated as 30 percent disabling, and
an initial evaluation in excess of 30 percent for
post-traumatic stress disorder (PTSD).
VA is generally required to make reasonable efforts to assist
a claimant in obtaining evidence necessary to substantiate
the claim. 38 U.S.C.A. § 5103A(a) (West 2002). This duty to
assist includes the conduct of a thorough and comprehensive
medical examination. Robinette v. Brown, 8 Vet. App. 69, 76
(1995). Where the available evidence is too old for an
adequate evaluation of the veteran's current condition, VA's
duty to assist includes providing a new examination.
Weggenmann v. Brown, 5 Vet. App. 281, 284 (1993).
In this case, the veteran last underwent comprehensive VA
examinations of these service connected disabilities in
October 2004, approximately 3 years ago. The transcript of
the June 2007 videoconference hearing before the Board shows
that the veteran reported that these disorders had increased
in severity since that time. The Board therefore concludes
that additional VA examinations are needed to provide a
current picture of the service-connected disorders at issue
on appeal. 38 C.F.R. §§ 3.326, 3.327 (2006).
Accordingly, the case is remanded for the following actions:
1. The RO must provide notice as required
by Dingess/Hartman v. Nicholson, 19
Vet. App. 473 (2006).
2. The RO must make arrangements to
provide the veteran with an examination
to determine the current severity of
his service-connected residuals of
shell fragment wounds of the left wrist
and right hand. The claims file must
be made available to and reviewed by
the examiner. All pertinent
symptomatology and findings must be
reported in detail. Any indicated
diagnostic tests and studies must be
accomplished. The report of
examination must be comprehensive and
include a detailed account of all
manifestations of the left wrist and
right hand disorders found to be
present. In particular, the examiner
must state whether the veteran has
favorable or unfavorable ankylosis of
any joints or digits, limitation of
motion of any joints or digits,
disability of any muscle groups,
residual scarring, and complete or
incomplete paralysis of any nerve. If
incomplete paralysis of a nerve is
found, the examiner must state whether
it is best characterized as mild,
moderate, or severe. A complete
rationale for all opinions must be
provided. The report must be typed.
3. The RO must make arrangements to
provide the veteran with an examination
to determine the current severity of
his service-connected prostate cancer
residuals, to specifically include
urinary and bowel dysfunction. The
claims file must be made available to
and reviewed by the examiner. All
pertinent symptomatology and findings
must be reported in detail. Any
indicated diagnostic tests and studies
must be accomplished. The report of
examination must be comprehensive and
include a detailed account of all
residual disorders that the veteran
currently experiences as a result of
both his prostate cancer and the
treatment provided for the prostate
cancer. In regards to urinary and
bowel dysfunction, the examiner must
state the current manifestations of
these symptoms, to include such things
as: voiding frequency; use and
frequency of changing of absorbent
materials; renal dysfunction; frequency
of diarrhea, constipation, and
abdominal distress; residual
malnutrition; stricture of the rectum
and anus; and impairment of sphincter
control. A complete rationale for all
opinions must be provided. The report
must be typed.
4. The RO must make arrangements to
provide the veteran with an examination
to determine the current severity of
his service-connected PTSD. The claims
file must be made available to the
examiner for review in conjunction with
the examination. The examiner must
provide accurate and fully descriptive
assessments of all psychiatric
symptoms. The examiner must comment
upon the presence or absence, and the
frequency or severity of the following
symptoms due to PTSD: depressed mood;
anxiety; suspiciousness; panic attacks;
sleep impairment; memory loss;
flattened affect; circumstantial,
circumlocutory, or stereotyped speech;
difficulty in understanding complex
commands; impaired judgment; impaired
abstract thinking; disturbances of
motivation or mood; suicidal ideation;
obsessional rituals which interfere
with routine activities; intermittently
illogical, obscure, or irrelevant
speech; impaired impulse control;
spatial disorientation; neglect of
personal appearance and hygiene;
difficulty in adapting to stressful
circumstances; impairment in thought
processes or communication; delusions
or hallucinations; grossly
inappropriate behavior; persistent
danger of hurting self or others;
intermittent inability to perform
activities of daily living; and
disorientation to time or place. The
examiner must also enter a complete
multiaxial evaluation, and assign a
Global Assessment of Functioning score,
together with an explanation of what
the score represents in terms of his
psychological, social, and occupational
functioning. A complete rationale for
all opinions must be provided. The
report must be typed.
5. The RO must notify the veteran that it is
his responsibility to report for any VA
examination scheduled, and to cooperate
in the development of the claim. The
consequences for failure to report for a
VA examination without good cause may
include denial of the claim. 38 C.F.R.
§§ 3.158, 3.655 (2006). In the event
that the veteran does not report for any
scheduled examination, documentation must
be obtained which shows that notice
scheduling the examination was sent to
the last known address. It must also be
indicated whether any notice that was
sent was returned as undeliverable.
Copies of all documentation notifying the
veteran of any scheduled VA examination
must be placed in the veteran's claims
file.
6. The RO must then readjudicate the claims
and, thereafter, if any claim on appeal
remains denied, the veteran must be
provided a supplemental statement of the
case. After the veteran has had an
adequate opportunity to respond, the
appeal must be returned to the Board for
appellate review.
No action is required by the veteran until he receives
further notice; however, he may present additional evidence
or argument while the case is in remand status at the RO.
Kutscherousky v. West, 12 Vet. App. 369 (1999).
_________________________________________________
JOY A. MCDONALD
Veterans Law Judge, Board of Veterans' Appeals
Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the
Board of Veterans' Appeals is appealable to the United States
Court of Appeals for Veterans Claims. This remand is in the
nature of a preliminary order and does not constitute a
decision of the Board on the merits of your appeal. 38
C.F.R. § 20.1100(b) (2006).